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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002787
Report Date: 09/24/2024
Date Signed: 09/24/2024 12:28:41 PM


Document Has Been Signed on 09/24/2024 12:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:SIERRA OAKS OF REDDINGFACILITY NUMBER:
455002787
ADMINISTRATOR:BOBAN, KRISTINEFACILITY TYPE:
740
ADDRESS:1520 COLLYER DR.TELEPHONE:
(530) 241-5100
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:113CENSUS: 91DATE:
09/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Administrator, Kristine BobanTIME COMPLETED:
12:30 PM
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On September 24, 2024 at approximately 11:45 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Sierra Oaks of Redding for the purpose of conducting a Case Management-Incident Inspection. LPA was greeted at the door by Administrator, Kristine Boban, and was granted access into the facility.

On September 16, 2024, an incident report was forwarded to the California Department of Social Services-Community Care Licensing Division reflecting a Medication Error that occurred. Administrator reported that the Caregiver gave the wrong medication to a resident. Administrator reported no adverse reactions. Responsible Party and the Physician were notified (See LIC 9102-Technical Violation). LPA educated the Administrator on the importance of ensuring that ALL residents are being given the correct medications and dosages. As of right now, the Caregiver is no longer passing medication and is in training. LPA toured the facility with the Administrator and made observations.

No deficiencies were cited during today's Case Management-Incident Inspection . Exit interview was conducted and a copy of this report was signed and given to the Administrator.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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